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Date of Award

1-1-2026

Document Type

Dissertation - NSU Access Only

Degree Name

Doctor of Psychology (PsyD)

First Advisor

Christian DeLucia

Keywords

Empathy; Substance Use; Treatment

Abstract

ABSTRACT The adverse effects of substance use on empathy has been well established, yet the role of therapeutic interventions to restore or enhance empathy in individuals with problematic substance use has received little empirical attention. Current research reveals a lack of consensus regarding the impact of treatment on empathy, with a few longitudinal studies suggesting the potential importance of treatment, and cross-sectional studies presenting mixed results. The present study addressed this gap using an observational quasi-experimental design to examine longitudinal changes in empathy and perceived social support among individuals receiving intensive residential substance use treatment. The study also explored whether changes in empathy were associated with post-treatment substance use outcomes. Participants included 135 adults receiving residential substance use treatment. Patient self-report measures and therapist evaluations were completed at three time points, upon admission to treatment and two assessments during treatment. Participants also completed a follow-up assessment at two-months post-treatment. Individual growth curve modeling was used to examine trajectories of empathy and perceived social support while evaluating the effects of sex, medication-assisted treatment (MAT), and participant-rated therapist empathy. A logistic regression model examined whether individual differences in empathy trajectories predicted substance use following treatment. Contrary to the study hypotheses, self-reported empathy demonstrated a modest decline across treatment and follow-up, while perceived social support remained relatively stable over time. Although average empathy did not improve, substantial individual variability was observed in both baseline empathy and trajectories of change. Participant-rated therapist empathy was positively associated with baseline levels of self-reported empathy and perceived social support but was not associated with changes in either construct over time. Neither sex nor MAT significantly predicted empathy or perceived social support trajectories. Although the overall model predicting post-treatment substance use was not statistically significant, changes in empathy approached significance, suggesting that individuals demonstrating greater increases, or less pronounced declines in empathy were more likely to maintain abstinence following treatment. Findings suggest that empathy may not uniformly improve during intensive substance use treatment but instead may follow heterogeneous trajectories across individuals. Rather than focusing on average changes, future research should identify factors that contribute to individual differences in empathy trajectories and examine interventions that facilitate empathic functioning as a potential mechanism supporting sustained recovery.

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